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 Table of Contents  
CLINICAL CASE CORNER
Year : 2014  |  Volume : 1  |  Issue : 2  |  Page : 121-122

Elderly male who has insomnia, depression and excessive daytime sleepiness


1 Department of Psychiatry; Department of Sleep Clinic, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
2 Department of Pulmonolgy, Himalayan Institute of Medical Sciences; Department of Sleep Clinic, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India

Date of Web Publication3-Mar-2015

Correspondence Address:
Dr. Ravi Gupta
Department of Psychiatry, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Doiwala, Dehradun - 248 140, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-9995.152451

Rights and Permissions

How to cite this article:
Gupta R, Dhyani M, Sindhwani G. Elderly male who has insomnia, depression and excessive daytime sleepiness. J Geriatr Ment Health 2014;1:121-2

How to cite this URL:
Gupta R, Dhyani M, Sindhwani G. Elderly male who has insomnia, depression and excessive daytime sleepiness. J Geriatr Ment Health [serial online] 2014 [cited 2019 Dec 15];1:121-2. Available from: http://www.jgmh.org/text.asp?2014/1/2/121/152451

Dear Friends,
To encourage participation of all our readers, we are starting with a Clinical Case Corner, in which you will be provided with a case vignette/case description in the form of clinical history and investigation findings. This will be followed by few questions. You are required to respond to the questions based on your assessment of the case. Few of the correct responses will be published in the next issue of the journal.
Editor, JGMH
Please send your responses for this clinical case corner to the Editor (drsandeepgg2002@yahoo.com)



  Case Description Top


Mr. A 61-year-old male presents with complaints of sleep talking for 3 years, snoring for 3 years, pain in leg for 1½ years, falling asleep at odd times for 1-year and nonrefreshing sleep for 1-year in your clinic.

According to him, problems are getting worse with time. These symptoms are affecting his work performance, social activity and family life.

He usually goes to bed at 9 PM to wake up at 7 AM. After retiring to bed, he usually falls asleep within 30 min. He wakes up naturally in the morning feeling drowsy and able to leave the bed after waking up in 60 min. He usually sleeps on his sides i.e., in lateral position. He takes a planned nap lasting 30 min each day and feels alert after waking up. Grossly his prebed sleep hygiene appears normal.

For past 1-year, he often wakes up at night (2-3 times) to visit the washroom. After nocturnal awakening he falls back asleep in 15 min. He dreams almost daily, and his dreams are anxiety provoking. He reports an increased frequency of dreaming since past 7 months. He sometimes talks during sleep.

Before going to bed, he experiences some restless sensations in the legs along with the compulsion to move them. These sensations last 1-2 h and improve with massage. They worsen during the periods of inactivity and are worse in evening.

He has been told that he snores (Grade III). He has experienced difficulty breathing while lying supine. He is a restless sleeper, and he had awakened with the choking sensation during the night. His bed partner had noticed that his respiration stops during sleep. He has experienced a reflux of food, during the night; he sweats a lot during the night. His mouth often dries up during the night, and he experiences the heaviness in head in the morning. His Epworth Sleepiness Scale score is 12. He feels tired during the day, is losing memory, reports difficulty in concentrating on work and has become irritable these days. He also feels depressed.

He smokes nearly one bundle of beedi per day since past 15 days. Earlier he used to smoke around 30-40 beedis/day since the age of 7 years. He never consumed alcohol. He has retired from the job but follows a proper sleep wake schedule on most of the days. No history suggestive of the change in dreaming in past few days. No history suggestive of circadian rhythm sleep disorder or any violent parasomnia. No history to suggest presence of any childhood sleep disorder. He also has hypertension and chronic obstructive lung disease. There is no evidence of diabetes, hypothyroidism, coronary artery disease, neuro-cognitive disorder, stroke, congestive heart failure or chronic kidney disease. He denies history of hematopsis or having anxiety. Surgical history is nonremarkable. No history of any allergy to any of the drugs. No family history to suggest any sleep disorder in family member. According to him, his health is poor and he has gained 10 kg of weight in past 1-year.

Examination shows central obesity with body mass index of 30.2 and neck circumference of 42 cm. Sub-mental fat is conspicuous. He has high arched palate, hanging soft palate and edematous uvula. Nasal airway is clear bilaterally. His breathing is labored, and bilaterally rhonci are audible on chest ausultation. His blood pressure is 150/88 mmHg, and pulse is regular and rhythmic (94/min).

Overnight Level-1 Polysomnography was done, and its epoch is shown here [Figure 1].
Figure 1: 2 min epoch from the polysomnography. Similar findings were evident whole night

Click here to view



  Clinical Questions for Which You Should Send Your Responses ? Top


  1. What is/are the diagnosis?
  2. Which other investigations are required besides polysomnography?
  3. What does the polysomnography epoch shows?
  4. How will you manage this case?



    Figures

  [Figure 1]



 

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